LYMPHEDEMA Self-Care Guide

Transcription

1 Self-Care Guide What is Lymphedema? Lymphedema is a condition in which fluid and protein accumulate in the extravascular interstitial spaces of a limb. This condition is the most chronic complication after dissection of lymph nodes. Secondary lymphedema can cause pain, discomfort, decreased mobility, cellulitis and lymphangitis. Lymphedema is a chronic condition that is not curable at present. Lymphedema Measurements (centimeters) - Arm Arm MCPs Wrist Left Right Lymphedema Measurements (centimeters) - Leg Leg MTPs Ankle Left 10cm Below 15cm Above Lat. Epicondyle Lat. Epicondyle 10cm Below 15cm Above Lat. Femoral Condyle Lat. Femoral Condyle Right

2 Upper Extremity Risks Upper Extremity Tips to Reduce the Risk of Lymphedema after Cancer Treatments Surgery with axillary node dissection Scar formation Radiation to breast, axillary, internal mammary or subclavicular nodes Drain and/or wound complications infection Axillary web syndrome Seroma formation Advanced cancer Obesity Congenital predisposition Trauma to the at risk arm Chronic skin disorders and inflammation Hypertension Taxane chemotherapy Air travel Surgery with inguinal node dissection Postoperative pelvic radiation Infection Obesity Varicose vein stripping Genetic predisposition Advanced cancer Intra pelvic or intra abdominal tumours Orthopaedic surgery Poor nutrition Thrombophlebitis Chronic skin disorders and inflammation Immobilisation, prolonged limb dependency Air travel Early diagnosis results in more effective treatment, possible prevention, and less severe lymphedema Take care of nails and skin Maintain optimal body weight (BMI <30 kg/m2) Eat a balanced diet Avoid trauma to affected area Avoid tight clothing and jewellery Avoid exposure to extreme cold and heat Avoid blood pressure test in affected arm Use sunscreen and bug repellent Wear garments Exercise (initiate exercise as soon as possible) Elevate limb Lymphedema Framework. International consensus. Best Practice for the management of lymphoedema. London, UK: Medical Education Partnership Ltd; 2006.

3 Signs and Symptoms of Cellulitis: Skin Care Redness of the skin Swelling Drainage or leakage Tender lymph nodes Warmth Fever Pain and tenderness General Principles for Good Skin Care Skin Condition Description Wash daily Ensure skin folds are clean Monitor skin for cuts, bites, abrasions, burns Moisturize your skin every day by gently smoothing in non-perfumed cream or oil. This helps the skin to remain supple and in good condition. Avoid extreme temperatures No injections or blood pressure in that arm See a chiropodist for foot and nail care if you need extra help and let him or her know you have lymphedema. Make sure you wear well-fitting shoes. Folliculitis Fungal infection Lymphangiectasia Papillomatosis Lymphorrhea Ulceration Venous eczema Inflammation of the hair follicles Moist, whitish, scaling and itching commonly in skin folds Soft fluid filled projections caused by dilation of the lymphatic vessel Firm raised projections caused by dilation of the lymphatic vessel and fibrosis Occurs when lymph leaks from the skin surface Open wound, will need specialist referral Skin becomes pigmented, inflamed, scaly and itchy. Often associated with varicose veins and located most commonly around the ankles Contact dermatitis The result of allergic or irritant reaction. Skin becomes red, itchy, scaly and may weep or crust. Lymphedema Framework. International consensus. Best Practice for the management of lymphoedema. London, UK: Medical Education Partnership Ltd; 2006.

4 Self-Massage: Arm General Tips Always direct massage towards working lymph nodes (i.e. neck) Begin your sweeps closest to the body (proximal) and move outwards along the extremity (distal) Apply gentle pressure Try to elevate the limb while massaging Arm Self Massage Deep breathing (Belly breaths) X 15 Inhale through your nose, exhale through your mouth Locate the hollow above the collarbone with your fingertips. Gently stretch the skin in a circle toward the neck and release. Repeat 15 times On your unaffected side (if you have not had lymph nodes removed) place your finger tips at the outside edge of your breast (close to your arm pit). Gently stretch the skin in circles and release. Repeat 15 times. On both sides, place your fingertips along your groin crease. Gently stretch the skin in a circular motion and release. Repeat 15 times. Place your full hand in the armpit against the ribcage of your affected side. Using gentle motions, slowly sweep downwards towards your belly. Repeat 15 times. Place your full hand 1/3 of the way down your upper arm. Using gentle motions, sweep up the arm, around the front part of your shoulder, and towards the neck. Repeat 15 times. Place your hand 2/3 of the way down your upper arm and sweep up the arm, around the front part of your shoulder, and towards the neck. Repeat 15 times. Move your hand to the elbow and continue to sweep up the arm, around the front part of your shoulder, and towards the neck. Repeat 15 times. From your wrist, sweep up the arm, around the front part of your shoulder, and towards the neck 15 times. Do this on the front and backside of the forearm.

5 Self-Massage: Leg General Tips Always direct massage towards working lymph nodes Begin your sweeps closest to the body (proximal) and move outwards along the extremity (distal) Apply gentle pressure Try to elevate the limb while massaging Leg Self Massage Take deep belly breaths by inhaling through your nose and exhaling through your mouth. Repeat 15 times. Locate the hollow above the collarbone with your fingertips, gently stretch the skin in a circle toward the neck and release. Repeat 15 times. Place your finger tips at the outside edge of your breasts (close to your arm pit) and gently stretch the skin in circles and release. Repeat 15 times. On your unaffected side place your fingertips along your groin crease. Gently stretch the skin in a circular motion and release. Repeat 15 times. Place your full hand at groin against your affected side. Using gentle motions, slowly sweep upwards towards your belly. Repeat 15 times. Place your full hand 1/3 of the way down your thigh. Using gentle motions, sweep up the leg, towards the belly. Repeat 15 times. Place your hand 2/3 of the way down your thigh and sweep up the leg, towards the belly. It may be very difficult to reach down your leg, so use a paint roller with an extended handle (ask a professional for help). Repeat 15 times. Move your hand to knee and continue to sweep up the leg, around any scars, and towards the belly. Repeat 15 times. From your ankle, sweep up the leg, around any scars, and towards the belly Repeat 15 times. Do this on the front and backside of the leg. You may need an assistive device to reach the lower leg and foot.

6 1 LYMPHEDEMA Bandaging General Principles Short stretch have a high working pressure and a low resting pressure Start bandaging fingers towards arm pit Prevent creases Apply addition padding to boney areas or near creases Apply bandages at 50% extension and 50% overlap Use several layers Assess security, comfort, sensation, mobility and circulation after bandaging 5 7 6

7 1 LYMPHEDEMA 10 Bandaging 2 General Principles 9 Short stretch have a high working pressure and a low resting pressure Prevent creases Apply addition padding to boney areas or near creases 3 Apply bandages at 50% extension and 50% overlap 8 Use several layers Assess security, comfort, sensation, mobility and circulation after bandaging

8 Compression Garments Compressive garments are used in the long term management of Lymphedema. They may be used for prophylaxis, in the initial treatment or for maintenance. Flat Knit Suitability Criteria Flat Knit Garments Intact skin Custom made Minimal shape changes of the limb Minimal pitting Swelling that can be contained by compression Ability to tolerate garments Ability to monitor skin condition Firmer and thicker Difficult to put on and take off Worn during day Circular Knit Garments Ready to wear Thinner than flat knit Self management (client is able to put on and take off) More cosmetically acceptable Worn during day Circular Knit

9 Exercises: Arm Exercise will: Improve quality of life Attain or maintain healthy Body Mass Index Reduce risk of Lymphedema Manage Lymphedema Improve functional capacity Exercise Log Week Strength Aerobic Comments

10 Exercises: Leg

11 How to Find Your Target Heart Rate Formula THR= (220 age)0.6 to (220 age)0.8 Example for 60 80% MHR for a 65 year old female THR= (220 65) 0.6 to (220 65) 0.8 THR= 155(0.6) to 155 (0.8) THR= 93 bpm to 124 bpm Therefore the target heart rate is: 93 bpm to 124 bpm Rate of Perceived Exertion Scale (RPE) Borg Scale Modified Borg Scale Scale Perception of Effort Scale Perception of Effort 6 20% effort 0 No breathlessness at all 7 30% effort very, very light (rest) 0.5 Very, very slight (Just noticeable) 8 40% effort 1 Very slight 9 50% effort very light gentle walking 2 Slight breathlessness 10 55% effort 3 Moderate 11 60% effort fairly light 4 Some what severe 12 65% effort 5 Severe breathlessness 13 70% effort somewhat hard steady pace 6 Determine your target heart rate below: THR= (220 ) 0.6 to (220 ) 0.8 THR= (0.6) to (0.8) THR= bpm to bpm Therefore the target heart rate is: bpm to bpm 14 75% effort 7 Very severe breathlessness 15 80% effort hard % effort 9 Very, very severe (Almost maximum) 17 90% effort very hard 10 Maximum 18 95% effort % effort very, very hard Represents target range 20 Exhaustion

12 Lymphatic Cording Lymphatic cording looks like a guitar string. The symptoms are pain and tightness, and limitation of movement. Treatment of Lymphatic Cording Active and passive stretching DARE stretch Skin traction techniques Soft tissue and cord stretching Hooking manipulation Scar release techniques Lymphatic Cording Can Cause: Manual lymph drainage or self massage Light compression or bandaging Exercises Pain and avoidance of movement Adaptive postures Limited range of motion Limitations in activity and function Area around cord may look swollen Soft tissue dysfunction Risk for lymphedema

13 Community Resources LymphNotes An independent source of objective information for individuals living with lymphedema You can also communicate with others living with lymphedema. Lymphovenous A great source of un-biased information provided by certified Canada health care/rehab professionals and scientists CancerConnection: A place for Canadians living with or at risk for lymphedema to Lymphedema Sup- share information and offer support port Group Online LANA-Lymphology Association of North America A place to search for a certified therapist in your area LAO-Lymphedema Association of Ontario Provides care programs and services to people with lymphedema